Exploring the perceptions of Chinese adults toward overweight and obesity: A systematic literature review.

Abstract

Introduction: The prevalence of obesity among the Chinese population has increased more than three-fold over the last twenty years. It is crucial to understand Chinese people's perceptions toward obesity to inform effective weight management initiatives. This bilingual systematic review aimed to synthesize the existing literature regarding the perceptions of Chinese adults toward overweight and obesity and provide insight on methodological implications and future research directions.

Method: Six databases were searched from inception to 8th January 2025. Studies were included if they were published in English or Chinese, investigated perceptions toward overweight and obesity, and focused on Chinese adults living in or outside of Mainland China. Thematic synthesis was employed for data analysis.

Results: Fifty-three studies (24 in English, 29 in Chinese) were included, involving 83,688 participants. Three themes were identified; (1) Chinese adults connected obesity with appearance more than with health, (2) Chinese adults lacked practical knowledge to manage obesity, and (3) living with obesity was perceived as a solitary journey.

Conclusion: Most studies were conducted on Chinese people within the healthy weight range, who predominantly focused on appearance-oriented weight perception. There was a strong motivation for weight control, but a lack of practical weight loss strategies among Chinese adults.

Practitioner applications: The lack of practical weight management knowledge and weight loss failures lead to low self-efficacy, which may be mistaken as low motivation for weight management among Chinese adults. However, Chinese adults generally have the motivation to control their weight. It is important to empower Chinese people living with overweight or obesity with practical skills and increase self-efficacy through a multidisciplinary and affordable approach. The psychological burden caused by obesity stigma and the influence of Chinese culture makes the weight management journey lonely and challenging for Chinese adults living with overweight and obesity. Practitioners may need to openly address these issues and help reduce the mental burden toward more effective weight loss interventions.